心脏起搏及ICD适应征__培训课件.ppt

* It is important to be able to able to increase heart rate with activity (chronotropic competence). The pacemaker and mode selected should provide the ability to increase rate with activity either by 搕racking?the sinus node or, if the sinus node is not chronotropically competent, by providing the rate response via a sensor. * Candidates for pacemaker implantation may present with any of the above symptoms or conditions. * In a bipolar system, body tissue is part of the circuit only in the sense that it affects impedance (at the electrode-tissue interface). In a unipolar system, contact with body tissue is essential to ground the IPG and allow pacing to occur. * * The American College of Cardiology and the American Heart Association have determined guidelines for pacemaker implantation. These 1998 guidelines are divided into three classes. Class II has subcategories A and B. Gregoratos G, et al. ACC/AHA guidelines for Implantation of cardiac pacemakers and antiarrhythmia devices: a report of the ACC/AHA Task Force on Practice Guidelines (Committee on Pacemaker Implantation). J Am Coll Cardiol. 1998:31; 1175-1206. * In addition to classification, recommendations that are evidence based were added to descriptions. For example: Class I indication for symptomatic third-degree AV block was designated with a 搇evel of evidence: C? For the sake of brevity, this presentation will not include evidence based recommendations. For a complete listing of recommendations, consult JACC , April 1998. Gregoratos G, et al. ACC/AHA guidelines for Implantation of cardiac pacemakers and antiarrhythmia devices: a report of the ACC/AHA Task Force on Practice Guidelines (Committee on Pacemaker Implantation). J Am Coll Cardiol. 1998:31; 1175-1206. * Class I Indication(s): 1. Documented symptomatic sinus bradycardia, including frequent sinus pauses that produce symptoms. May be due to long-term drug therapy of a type and dose for which there is no accepted alternative 2. S